"We truly deliver the best care when different teams come together"
We talk to Mr Sotirios Saravelos, consultant gynaecologist and subspecialist in reproductive medicine, about his role caring for both NHS and private patients at Imperial College Healthcare.
What is your role at Imperial College Healthcare NHS Trust?
"I am a consultant gynaecologist and subspecialist in reproductive medicine. I work across St Mary’s and Hammersmith hospitals, mainly in the IVF unit at the Wolfson Fertility Centre. My role is essentially helping people have babies – from single women to heterosexual and same-sex couples. At the Centre we also offer fertility preservation for people who have been diagnosed with cancer to enable them to have babies in the future. We also support patients with complex medical conditions (such as kidney transplants) who are struggling to have a baby and even patients with rare conditions such as Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) – a condition where women are born without a uterus."
How does your role allow you to care for both NHS and private patients?
"Working within Imperial College Healthcare we have the unique opportunity to care for both NHS and private patients. It is a particular privilege to be able to offer fertility treatment under the NHS, particularly for couples who would not be otherwise able to fund their own treatment. We also run private clinics and treatments for couples who wish to have treatment privately or who have exhausted their NHS funding, for example if they have completed treatment with us previously and have already had one baby successfully."
What are some of the benefits of working across both NHS and private services?
"Our unit is unique because it combines the NHS, private and academic arms of Imperial College Healthcare. This means that all our patients are able to benefit from us working closely with world-class pioneering teams in other disciplines that may contribute to the care of some of our patients. For example, the early pregnancy team, the recurrent miscarriage team, the fetal and obstetric medicine team, the gynaecological oncology team and many others. The Wolfson Fertility Centre has traditionally had staff coming from all over the world to work and gain further experience in our unit."
At Imperial College Healthcare, all funds generated by our private care services are continually reinvested back into the Trust, to support both NHS and private services. Can you give some examples of how this reinvestment has benefited your department?
"Our unit opened in 1982 and is responsible for the first IVF baby in London. It was also a world pioneer in treatments such as embryo biopsies. Forty years later, we are able to remain at the forefront of innovation and treatment due to funds generated from our private services. The unit recently underwent a renovation of our theatre and recovery space, and maintains the highest quality of ultrasound and laboratory equipment, which ensures that we are able to offer the highest possible quality of care."
What role is AI increasingly playing in reproductive medicine?
"One of the key challenges with fertility treatments is that success is not always guaranteed, and nature still plays a very key role in determining whether treatment will lead to a successful pregnancy. However, in the last few years we have seen tremendous developments in the field. For example, we are now able to collect eggs in cases that were previously considered very challenging. The laboratories have also developed significantly and are now able to routinely freeze and thaw eggs and embryos for treatment. This has led to treatments previously considered experimental, to nowadays being considered routine.
"There are also very exciting developments in the field of genetics and AI. One of the biggest challenges in IVF is being able to identify the embryos that are likely to become a healthy baby, as not all of them are able to do so. Analysing the genetic composition of each embryo may eventually help us identify which embryos to transfer. Equally, using AI and machine learning to monitor the shape of the cells and the speed at which the embryo develops and reaches certain milestones, may allow us to identify the embryos that are more likely to succeed. These are very exciting developments, especially in light of the physical and emotional toll assisted fertility treatments can have on our patients."
More generally, what would a typical fertility journey look like at the Wolfson Fertility Centre?
"When patients come to us, the first step is to identify why an individual or couple might be struggling to have a baby. Usually, if they haven’t become pregnant within a year of trying, we tend to recommend investigations. About one third of causes of infertility may be down to female causes (e.g. women may have blocked tubes, or may not be ovulating). About one third of causes may be due to male factors (e.g. the number of sperm may be low, the movement may be poor, or the shape of the sperm may be abnormal). Lastly, about one third of the causes may be mixed male/female causes, or unexplained. The main takeaway of this is that infertility is definitely not a ‘female’ problem – as we have historically been led to believe.
"Once we have identified the cause of infertility, we can then offer treatment. For example, if a woman isn’t ovulating, we can give them simple tablets to help them ovulate. IVF is not the first resort but rather the last resort. We often start with the most natural and less invasive forms of treatment, and when we don’t have any further options or when simple options have failed, we employ IVF, which can often achieve the highest rate of success.
"With IVF, we wait for a woman to have a period and then we do a scan to make sure that the month we’re aiming to do treatment is a good month. We then give patients injections to grow as many eggs as possible. In a natural cycle, a woman who is ovulating and has regular periods will generally release one egg per month. However, with medication, women have the potential to release many more eggs per month (on average 8-12) and that’s something we can achieve by giving injections to stimulate the ovaries. After a couple of weeks of monitoring egg growth via blood tests and scans, we perform what is known as an egg collection.
"This is a procedure under sedation whereby we do an internal scan and use a little needle that goes into the ovaries and tries to collect the eggs. We then pass the eggs onto an embryologist and at the same time the male partner will produce a sperm sample which will be introduced to an egg within a lab to fertilise. This can happen in two ways – one option is to leave the sperm and eggs in a dish overnight to see if they fertilise (i.e. join) by the morning. The other option, when the sperm is very week, is to inject the healthiest sperm into an egg directly in the lab (this is called ICSI).
"Once an egg and sperm fertilise to form an embryo, these are placed in an incubator so they can grow. On the fifth day of development, an embryologist will look under a microscope to identify the healthiest embryo to transfer into the uterus of a woman in a procedure similar to a smear test."
What do you love most about your job?
"I love that I’m able to help patients achieve their dream of having a family, often against all odds. I also love the fact that my job combines cutting edge science and surgical procedures with supporting patients through really sensitive and emotional personal journeys – journeys that will stay with them for the rest of their lives. I also love that a lot of our treatments are still funded by the NHS, because I feel that having a family should be a basic human right. My research and collaborations have also allowed me to work and lecture in different hospitals and universities throughout the world (within Europe and Asia), which is really unique.
"I also love how collaborative my role is – I can help patients with MRKH and cancer to have a baby but only because these patients are referred to the Centre via different teams and departments at the Trust and across the UK. We truly deliver the best care when different teams come together."
What have been some of your proudest moments to date?
"Some of my proudest moments have been where we have come together as a team to help patients with complex conditions, who were otherwise told that having a baby would not be possible, achieve their dream. The experience and joy shared with the patients from such cases is immeasurable."
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